Medicaid Reimbursement for Spinal Surgery Varies Between States
Most states reimburse less for spinal surgery in Medicaid patients compared with Medicare patients, according to a study from The Rothman Institute at Thomas Jefferson University Hospital recently published online by Spine.
The study shows disparities between Medicare and Medicaid reimbursement for identical procedures within states, as well as wide variations in Medicaid reimbursement for spinal surgery between states. According to the researchers, “It is likely that these discrepancies lead to suboptimal access to necessary spinal care.”
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The researchers performed an online search to identify each state’s Medicaid reimbursement rates for 8 of the most commonly performed spinal surgical procedures, including various spinal fusion and decompression procedures. They analyzed discrepancies between Medicaid and Medicare reimbursement on a state-by-state basis. (Note: Delaware, Kansas, Pennsylvania, and Tennessee do not have publicly available data on Medicaid reimbursement.)
On average, reimbursement for spinal surgery in Medicaid patients was 78% of the reimbursement for the same procedure in Medicare patients. But there was significant variation between states: For the 8 procedures combined, Medicaid reimbursement ranged from 39% to 140% of Medicare reimbursement.
Medicaid reimbursement was less than 50% of Medicare reimbursement in 4 states: New York, New Jersey, Florida, and Rhode Island. In another 4 states – Alaska, Arkansas, Nebraska, and South Dakota – Medicaid reimbursement was higher than Medicare reimbursement.
In 20 states, Medicaid reimbursement was less than 75% of Medicare reimbursement. Overall, 43 states reimbursed less for spinal surgery in Medicaid patients than for Medicare patients. The variation between states was largest for microdiscetomy.
Low reimbursement has been identified as an important barrier to healthcare access for Medicaid patients, particularly for specialty surgical care. According to the study authors, “due to significantly lower rates of reimbursement, it is thought that fewer physicians are willing to take on new Medicaid patients, as they are unable to receive compensation commensurate with their services.”
This new study confirms that most states reimburse less for common spinal surgery procedures in Medicaid patients compared with Medicare patients. The reasons for the variation between states are unclear. The authors suggest that many different factors may be involved, including political climate, budget agendas, and individual state economics.
“Using consistent, fair reimbursement as a proxy to equal care, this study…provides reasons as to why Medicaid patients often have difficulty obtaining appropriate medical care,” the authors conclude. “Standardizing reimbursement rates among insurance providers to a level appropriate for the services provided would likely improve access to care for Medicaid patients.”
Casper DS, Schroeder GD, McKenzie J, et al. Medicaid reimbursement for common spine procedures: are compensation rules consistent? Spine. 26 September 2019. [Epub]. doi: 10.1097/BRS.0000000000003241.